In NYC where I live, there’s a sign on the side of a building–on West 72nd Street, to be exact– which claims that “Depression is a flaw in chemistry, not character…” It is, in my opinion, obvious that depression is NEVER a flaw in character–what an absurd notion. But what about the reverse; is it always a flaw in chemistry? IS IT A FLAW AT ALL? If it is one, then we must rush to correct it; but perhaps the depressed person–for example, the prostate cancer survivor or his partner–is simply mourning for what is lost, coping with a new and scary landscape, searching for a new identity.

There has been much recent flap lately in PCa circles about how to cope with the depression that often follows treatment. Whatever treatment it was: prostatectomy, seeds, beam radiation, cryo, chemo, hormones, proton beam, even HIFU, it is likely to have changed forever the way a man lives and experiences himself as a sexual being. Then there’s the flip-side depression: the partner’s. What do you do when you’re the one left back on shore, the one whose body hasn’t forever been altered? The one, perhaps, whose libido is still active?

Some people are turning to antidepressants, and some doctors are advocating this kind of treatment. On the man’s side, the fact that many such drugs hardly enhance erectile function should certainly be discussed. Beyond this, however, what is there in our culture that spurs us on to medicate everything?

Perhaps the way to cope is to go running or listen to music or redefine yourself as you are now. Join a community of others who have suffered the same way. Reach for the person on the other side of the room–or the bed; and don’t be afraid of who you are now. Depression may just be the bridge to the next part of your life. That’s what I’d say to anyone, post prostate cancer, who reaches first for a bottle of pills.

Why is libido the dark undiscussed corner of male sexuality? If you read Dana Jennings’ blog on the The New York Timeswebsite, he talks about libido as distinct from erectile function, but not many other men who are prostate cancer survivors do. And yet, women who suffer from sexual dysfunction talk mainly about their libidos. It would seem that for men sexuality is forever linked to the mechanics of the penis, so much so that libido is cast aside and forgotten.

There is a great difference between the desire to have traditional sex and the ability. Of the two, the greater and subtler challenge is desire: without it, even a man who has solved the problem of mechanics via pills, a prosthesis or a vacuum device is likely to have a hollow or ironic experience.

Out of the corner of his eye, my husband saw me in a revealing blouse, and it did something. But the lovely moment vanished, and we haven’t been able to get anything like it back for months. Dana Jennings describes similar moments. That’s how it is. There are a lot of guys out there with zero motivation on account of hormone ablation, which keeps the body from producing testosterone. In some men the loss of libido post hormone treatments is permanent; in others temporary. Nobody knows why. Only recently have some doctors begun to discuss these effects frankly with their patients before treatment. Each of us—both Pca men and the partners who live with them—has a different thing to struggle against…what an intricate process cancer survival can be.